A Veteran Psychiatrist/Parent/Writer Observes the American Culture

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High costs, in point of fact the highest cost of pharmaceuticals, have been a given for the resident of the United States. Citizen/health care consumers of these drug prices have pretty much accepted this state of affairs since the late 1980’s when under the Reagan administration, in anthromorphorzing view of the human-like actions of the big drug companies, upped their periscopes from the national headquarters bunkers, looked around at the regulatory landscapes, and saw the lack of regulation creating a manna from Heaven business opportunity for their business model and industry. And that was the realization that they could jack up prices even more and not get their knuckles rapped by the feds, or any of its past oversight, regulatory agencies.

And so, in my ‘industry, “healthcare,” [a term I and most providers hate unless they are more business types and less health care devotees in practice to make a decent living but mostly to serve their patients and ‘do good,] became ‘business-ized at the upper, larger, company levels. Hospitals started buying up medical, surgical, and specialty practices at huge rates for the last 20 years. Providers found themselves being squeezed, pressured and commanded to evolve into a factory-like production model of seeing as many patients in as short an individual time as possible. Seeing patients does not lend itself easily to the Henry Ford conveyer belt mass production manufacturing model that has been the basis of modern production and business model that has dominated the industrial revolution since the early 1900’s. But the medicine behemoths have tried. And now they have reached the limits of that as patients and providers have typically 15 minutes or less for histories, physicals, treatment planning, execution and referral and whatever else is called from. Solo practices have disappeared as the economics of a single revenue generator cannot pay the overhead anymore, e.g., purchasing and maintaining a high-end mandated health information and record keeping system that is also used to monitor the quality of care issues and determine level of reimbursement for that poor shcmuch doctor living and practicing in the past. Groups have had to expand greatly, buy out other practices mirroring the wave of mergers in all industries who have had to adopt the same strategy to stay competitive for decades.

Now with limits of squeezing out more and more revenue of a system that cannot increase production beyond a certain limit, unless unscrupulous money making practices such as ordering procedures for larger numbers of patients that are not needed, medicine is turning to big data as its saviour to somehow point to population-wide ventures based on disease management through data that tells the data trend sifters and analysts what could need new attention and new ways of inventing new health care measure and generating reimbursements for preventive services to the ‘still well.’ Wellness program, weight loss programs, stop smoking campaigns, yoga classes, preventive back injury exercise programs (do you know any furniture movers or long distance truck drivers who need those, actually taking and paying for them? No, I didn’t think so.